Skip to main content

Advertisement

Log in

A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia.

Patients and methods

A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared.

Results

Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach.

Conclusion

Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences.

Level of evidence

3 (Retrospective case–control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of data and materials

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM (1986) Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol 7:795–799

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Schady W, Metcalfe RA, Butler P (1987) The incidence of craniocervical bony anomalies in the adult Chiari malformation. J Neurol Sci 82:193–203. https://doi.org/10.1016/0022-510x(87)90018-9

    Article  CAS  PubMed  Google Scholar 

  3. Guan J, Yuan C, Yao Q et al (2023) A novel scoring system for assessing adult syringomyelia associated with CM I treatment outcomes. Acta Neurol Belg 123:807–814. https://doi.org/10.1007/s13760-023-02264-4

    Article  PubMed  Google Scholar 

  4. Houston JR, Maleki J, Loth F et al (2022) Influence of pain on cognitive dysfunction and emotion dysregulation in chiari malformation Type I. Adv Exp Med Biol 1378:155–178. https://doi.org/10.1007/978-3-030-99550-8_11

    Article  CAS  PubMed  Google Scholar 

  5. Balasa A, Bala A, Olejnik A et al (2023) Pain-depression relationship, quality of life and acceptance of illness among patients with Chiari malformation type I: a cross-sectional study. Medicine (Baltimore) 102:e33738. https://doi.org/10.1097/MD.0000000000033738

    Article  PubMed  Google Scholar 

  6. Dolas I, Yorukoglu AG, Sencer A et al (2023) Full-endoscopic technique for posterior fossa decompression in Chiari malformation type I: an anatomical feasibility study in human cadavers. Clin Anat N Y N 36:660–668. https://doi.org/10.1002/ca.24024

    Article  CAS  Google Scholar 

  7. Milhorat TH, Chou MW, Trinidad EM et al (1999) Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 44:1005–1017. https://doi.org/10.1097/00006123-199905000-00042

    Article  CAS  PubMed  Google Scholar 

  8. Yahanda AT, Limbrick DD (2023) Posterior fossa decompression with or without duraplasty for Chiari I malformation. Neurosurg Clin N Am 34:105–111. https://doi.org/10.1016/j.nec.2022.08.008

    Article  PubMed  Google Scholar 

  9. Aliaga L, Hekman KE, Yassari R et al (2012) A novel scoring system for assessing Chiari malformation type I treatment outcomes. Neurosurgery 70(3):656–665. https://doi.org/10.1227/NEU.0b013e31823200a6

    Article  PubMed  Google Scholar 

  10. Portella ST, Escudeiro GP, Mansilla R et al (2019) Predictive factors for muscle injury after posterior lumbar spinal surgery. World Neurosurg 129:e514–e521. https://doi.org/10.1016/j.wneu.2019.05.197

    Article  PubMed  Google Scholar 

  11. Sang P, Ma Y, Chen B, Zhang M (2021) The role of serum creatine kinase levels in anterior cervical spinal surgery: change trends and risk factors. Medicine (Baltimore) 100:e28300. https://doi.org/10.1097/MD.0000000000028300

    Article  CAS  PubMed  Google Scholar 

  12. Yoshimoto M, Miyakawa T, Takebayashi T et al (2014) Microendoscopy-assisted muscle-preserving interlaminar decompression for lumbar spinal stenosis: clinical results of consecutive 105 cases with more than 3-year follow-up. Spine 39:E318-325. https://doi.org/10.1097/BRS.0000000000000160

    Article  PubMed  Google Scholar 

  13. Lombao Iglesias D, Bagó Granell J, Vilor Rivero T (2014) Validity of creatine kinase as an indicator of muscle injury in spine surgery and its relation with postoperative pain. Acta Orthop Belg 80:545–550

    PubMed  Google Scholar 

  14. Yamada S (2021) Cerebrospinal fluid dynamics. Croat Med J 62:399–410. https://doi.org/10.3325/cmj.2021.62.399

    Article  PubMed  Google Scholar 

  15. Logue V, Edwards MR (1981) Syringomyelia and its surgical treatment—an analysis of 75 patients. J Neurol Neurosurg Psychiatry 44:273–284. https://doi.org/10.1136/jnnp.44.4.273

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chang T-W, Zhang X, Maoliti W et al (2021) Outcomes of dura splitting decompression versus posterior fossa decompression with duraplasty in the treatment of chiari I malformation: a systematic review and meta-analysis. World Neurosurg 147:105–114. https://doi.org/10.1016/j.wneu.2020.11.163

    Article  PubMed  Google Scholar 

  17. Marshman LAG, Benjamin JC, Chawda SJ, David KM (2005) Acute obstructive hydrocephalus associated with infratentorial subdural hygromas complicating Chiari malformation Type I decompression. Report of two cases and literature review. J Neurosurg 103:752–755. https://doi.org/10.3171/jns.2005.103.4.0752

    Article  PubMed  Google Scholar 

  18. Osborne-Grinter M, Arora M, Kaliaperumal C, Gallo P (2021) Posterior fossa decompression and duraplasty with and without arachnoid preservation for the treatment of adult chiari malformation type 1: a systematic review and meta-analysis. World Neurosurg 151:e579–e598. https://doi.org/10.1016/j.wneu.2021.04.082

    Article  PubMed  Google Scholar 

  19. Park JK, Gleason PL, Madsen JR et al (1997) Presentation and management of Chiari I malformation in children. Pediatr Neurosurg 26:190–196. https://doi.org/10.1159/000121190

    Article  CAS  PubMed  Google Scholar 

  20. Zagzoog N, Reddy KK (2019) Use of minimally invasive tubular retractors for foramen magnum decompression of chiari malformation: a technical note and case series. World Neurosurg 128:248–253. https://doi.org/10.1016/j.wneu.2019.04.094

    Article  PubMed  Google Scholar 

  21. Ratre S, Yadav N, Yadav YR et al (2018) Endoscopic management of arnold-chiari malformation type i with or without syringomyelia. J Neurol Surg Part Cent Eur Neurosurg 79:45–51. https://doi.org/10.1055/s-0036-1594011

    Article  Google Scholar 

  22. Lee HS, Lee S-H, Kim ES et al (2012) Surgical results of arachnoid-preserving posterior fossa decompression for Chiari I malformation with associated syringomyelia. J Clin Neurosci Off J Neurosurg Soc Australas 19:557–560. https://doi.org/10.1016/j.jocn.2011.06.034

    Article  Google Scholar 

  23. Pandey S, Li L, Wan RH et al (2020) A retrospective study on outcomes following posterior fossa decompression with dural splitting surgery in patients with Chiari type I malformation. Clin Neurol Neurosurg 196:106035. https://doi.org/10.1016/j.clineuro.2020.106035

    Article  PubMed  Google Scholar 

  24. Litvack ZN, Lindsay RA, Selden NR (2013) Dura splitting decompression for Chiari I malformation in pediatric patients: clinical outcomes, healthcare costs, and resource utilization. Neurosurgery 72(6):922–929. https://doi.org/10.1227/NEU.0b013e31828ca1ed

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: GG, EÇ; Methodology: GG, EÇ, ZD; Formal analysis and investigation: EÇ, ZD; Writing-original draft preparation: EÇ, ZD; Writing-review and editing: AD, ADB; Funding acquisition: AD; Resources: GG; Supervision: ADB.

Corresponding author

Correspondence to Göksal Günerhan.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest or competing interests.

Consent for publication

All authors provide their consent for the publication of the study.

Consent to participate

Written signed informed consent was obtained from all patients who participated in the study, both for their involvement and for the surgical intervention. The risks and benefits of the procedure and the study were explained in detail.

Ethics approval

Ethics committee approval for this article was obtained from the Ministry of Health, Provincial Health Directorate, Clinical Research Ethics Committee No. 1, with the number E1-22-2650.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 78888 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Günerhan, G., Çağıl, E., Dağlar, Z. et al. A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08299-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00586-024-08299-2

Keywords

Navigation